Unfolding RN
Case Study
Bowel Elimination
, Building Clinical Judgment CS
Bowel Elimination Unfolding RN Case Study
(Answers and Rationales)
An 81-year-old patient is being seen by the nurse in an extended care living facility. The
patient is stating they are having abdominal pain and describes the pain as sharp, 8/10 and
in the hypogastric region. The patient stated that the pain has been off and on all night,
and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was
yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has
contractures. The patient states they have pain to left leg where lower leg used to be and
describes that pain as a 4/10. The patient can transfer from bed to wheelchair with
assistance pivoting on their unaffected right leg. The patient has a past medical history of
a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II
Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS,
aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID,
methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg
subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
1. Highlight the assessment findings that require immediate follow-up by the nurse.
An 81-year-old patient is being seen by the nurse in an extended care living facility. The
patient is stating they are having abdominal pain and describes the pain as sharp, 8/10 and
in the hypogastric region. The patient stated that the pain has been off and on all night,
and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was
yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has
contractures. The patient states they have pain to left leg where lower leg used to be and
describes that pain as a 4/10. The patient can transfer from bed to wheelchair with
assistance pivoting on their unaffected right leg. The patient has a past medical history of
a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II
Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS,
aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID,
methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg
subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
Rationale: This patient is having a problem with pain both in their abdomen and left lower
leg. Pain is worthy of immediate follow-up by the nurse to assess and relieve it. When
assessing pain, it is important for the nurse to include timing, location, severity using a pain
scale, quality, precipitating factors and relief measures. The other items in the patient’s
scenario such as denials of GI symptoms, urine output, LBM, transfer ability and medical
and medication history do not require immediate follow up.
Cognitive Skill: Recognize Cues
Case Study
Bowel Elimination
, Building Clinical Judgment CS
Bowel Elimination Unfolding RN Case Study
(Answers and Rationales)
An 81-year-old patient is being seen by the nurse in an extended care living facility. The
patient is stating they are having abdominal pain and describes the pain as sharp, 8/10 and
in the hypogastric region. The patient stated that the pain has been off and on all night,
and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was
yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has
contractures. The patient states they have pain to left leg where lower leg used to be and
describes that pain as a 4/10. The patient can transfer from bed to wheelchair with
assistance pivoting on their unaffected right leg. The patient has a past medical history of
a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II
Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS,
aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID,
methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg
subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
1. Highlight the assessment findings that require immediate follow-up by the nurse.
An 81-year-old patient is being seen by the nurse in an extended care living facility. The
patient is stating they are having abdominal pain and describes the pain as sharp, 8/10 and
in the hypogastric region. The patient stated that the pain has been off and on all night,
and does not radiate. Denies any vomiting, diarrhea or nausea during the night. LBM was
yesterday. Voided 680 mL of clear yellow urine in urinal this morning. Left arm has
contractures. The patient states they have pain to left leg where lower leg used to be and
describes that pain as a 4/10. The patient can transfer from bed to wheelchair with
assistance pivoting on their unaffected right leg. The patient has a past medical history of
a CVA, L BKA, hypercholesteremia, rheumatoid arthritis, chronic atrial fibrillation, Type II
Diabetes, and hypertension. Current medications include atorvastatin 40 mg one PO qHS,
aspirin 325 mg daily, clopidogrel 75 mg daily, acetaminophen 650 mg two tabs PO BID,
methotrexate 6 tabs once weekly, folic acid 0.8 mg one PO daily, semaglutide 0.5 mg
subcut weekly, metoprolol 50 mg one PO daily and multivitamin one daily.
Rationale: This patient is having a problem with pain both in their abdomen and left lower
leg. Pain is worthy of immediate follow-up by the nurse to assess and relieve it. When
assessing pain, it is important for the nurse to include timing, location, severity using a pain
scale, quality, precipitating factors and relief measures. The other items in the patient’s
scenario such as denials of GI symptoms, urine output, LBM, transfer ability and medical
and medication history do not require immediate follow up.
Cognitive Skill: Recognize Cues
